Provider Demographics
NPI:1710436191
Name:MSK DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:MSK DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-707-0005
Mailing Address - Street 1:3160 N TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8614
Mailing Address - Country:US
Mailing Address - Phone:469-814-8244
Mailing Address - Fax:
Practice Address - Street 1:3160 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8614
Practice Address - Country:US
Practice Address - Phone:469-814-8244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty